The aim of this systematic review was to summarize systematically the existing evidence for the effects of student participation in designing, planning, implementing and/or evaluating school health promotion measures. The focus was on the effects of participation in school health promotion measures rather than on student involvement at school in general. Participation is a core value for health promotion but empirical evidence of its outcomes is scarce. We searched major bibliographic databases (including ASSIA, ERIC, PsycINFO, Scopus, PubMed and the Social Sciences Citation Index). Two reviewers independently decided about inclusion and exclusion of the identified abstracts (n = 5075) and full text articles. Of the 90 full text articles screened, 26 papers met the inclusion criteria. We identified evidence for positive effects, especially for the students themselves, the school as organization, and interactions and social relations at school. Almost all included studies showed personal effects on students referring to an increased satisfaction, motivation and ownership, an increase in skills, competencies and knowledge, personal development, health-related effects and influence on student perspective. Given that student participation has more been discussed as a value, or ideal of health promotion in schools, these findings documenting its effectiveness are important. However, further research is needed to consider the level or intensity of involvement, different approaches and stages of participation in the health promotion intervention, as well as mediating factors such as gender, socio-cultural background or academic achievement, in a more systematic manner.

Networks have become a buzz word in the social sciences. Especially in the field of health promotion, they have, mostly going back to initiatives from the World Health Organi-zation (WHO), been a practice tool to support the implementation of health promotion in organizations since the late 1980s in as diverse settings as cities, hospitals, schools, islands, market places, and prisons (compare Dietscher 2011). However, despite more than 20 years of experience with the network approach in health promotion, a sound theory base for this ap-proach (except for work by Brößkamp-Stone [2004]), and especially concepts of network ef-fectiveness, are still widely missing.
One of the more elaborated networks in the settings approach of health promotion is the International Network of Health Promoting Hospitals and Health Services (HPH) that was founded in 1990. While this network, in its early phases, had been accompanied by interna-tionally comparative evaluation studies (however, with the main focus on the implementation of health promotion in participating hospital organizations) (compare e.g. Pelikan et al. 1998), HPH has, more recently, been criticized for being under-researched (e.g. Whitehead 2004). This applies especially to the network level of HPH: In 1995, the WHO Regional Office for Europe decided to make national and regional networks of HPH the main tool for the further dissemination of HPH and for supporting implementation in hospital (and health service) organizations. However, international research in HPH continued to focus on the hospital level (e.g. Gröne et al. 2010, Tonnesen et al. 2008), and no international comparative study of the national / regional networks of HPH existed so far.

Dietscher,C.(2013):

How can the functioning and effectiveness of networks in the settings approach of health promotion be understood, achieved and researched? Advance Access published in: Health Promotion International.

Networks in health promotion (HP) have, after the launch of WHO's Ottawa Charter [(World Health Organization (WHO) (eds). (1986) Ottawa Charter on Health Promotion. Towards A New Public Health. World Health Organization, Geneva], become a widespread tool to disseminate HP especially in conjunction with the settings approach. Despite their allegedly high importance for HP practice and more than two decades of experiences with networking so far, a sound theoretical basis to support effective planning, formation, coordination and strategy development for networks in the settings approach of HP (HPSN) is still widely missing. Brößkamp-Stone's multi-facetted interorganizational network assessment framework (2004) provides a starting point but falls short of specifying the outcomes that can be reasonably expected from the specific network type of HPSN, and the specific processes/strategies and structures that are needed to achieve them. Based on outcome models in HP, on social, managerial and health science theories of networks, settings and organizations, a sociological systems theory approach and the capacity approach in HP, this article points out why existing approaches to studying networks are insufficient for HPSN, what can be understood by their functioning and effectiveness, what preconditions there are for HPSN effectiveness and how an HPSN functioning and effectiveness framework proposed on these grounds can be used for researching networks in practice, drawing on experiences from the ‘Project on an Internationally Comparative Evaluation Study of the International Network of Health Promoting Hospitals and Health Services’ (PRICES-HPH), which was coordinated by the WHO Collaborating Centre for Health Promotion in Hospitals and Health Services (Vienna WHO-CC) from 2008 to 2012.

Previous research on the links between income inequality and health and socioeconomic differences in health suggests that relative differences in affluence impact health and well-being more than absolute affluence. This study explored whether self-reported psychosomatic symptoms in adolescents relate more closely to relative affluence (i.e., relative deprivation or rank affluence within regions or schools) than to absolute affluence. Data on family material assets and psychosomatic symptoms were collected from 48,523 adolescents in eight countries (Austria, Belgium, Canada, Norway, Scotland, Poland, Turkey, and Ukraine) as part of the 2009/10 Health Behaviour in School-aged Children study. Multilevel regression analyses of the data showed that relative deprivation (Yitzhaki Index, calculated in regions and in schools) and rank affluence (in regions) (1) related more closely to symptoms than absolute affluence, and (2) related to symptoms after differences in absolute affluence were held constant. However, differences in family material assets, whether they are measured in absolute or relative terms, account for a significant variation in adolescent psychosomatic symptoms. Conceptual and empirical issues relating to the use of material affluence indices to estimate socioeconomic position are discussed.

Flaschberger,E. (2013):

Initial teacher education for school health promotion in Austria - Does it support the implementation of the health-promoting school approach? Health Education, 113 (3), 216-231.

Purpose - School health promotion is said to be most effective when implemented through a comprehensive, settings-based, whole-school approach. The purpose of this paper is to address the current lack of knowledge about the current state of teacher education for health promotion and its potential to further the development of settings-based approaches.

Design/methodology/approach - This paper focuses on an analysis of initial teacher education for school health promotion in Austria by studying the curricula of the Universities of Teacher Education, as well as interviewing representatives from these institutions. A content analysis of the identified modules and a thematic analysis of the interview transcripts were conducted.

Findings - While there is more behaviour orientation than setting orientation identified in the curricula, the interviewees showed a broad understanding of health promotion that encompasses a settings view. The situation at the Universities of Teacher Education mirrors the situation in schools: there are similar supporting and hindering factors for the implementation of healthy settings.

Practical implications - A greater degree of focus in teacher education on the settings approach and the promotion of the skills required to implement it is needed, as well as the creation of health-promoting Universities of Teacher Education.

Originality/value - The study makes recommendations about how to prepare future teachers to support the development of more effective approaches of school health promotion.

To change a school into a health-promoting organization, organizational learning is required. The evaluation of an Austrian regional health-promoting schools network provides qualitative data on the views of the different stakeholders on learning in this network (steering group, network coordinator and representatives of the network schools; n = 26). Through thematic analysis and deep-structure analyses, the following three forms of learning in the network were identified: (A) individual learning through input offered by the network coordination, (B) individual learning between the network schools, i.e. through exchange between the representatives of different schools and (C) learning within the participating schools, i.e. organizational learning. Learning between (B) or within the participating schools (C) seems to be rare in the network; concepts of individual teacher learning are prevalent. Difficulties detected relating to the transfer of information from the network to the member schools included barriers to organizational learning such as the lack of collaboration, coordination and communication in the network schools, which might be effects of the school system in which the observed network is located. To ensure connectivity of the information offered by the network, more emphasis should be put on linking health promotion to school development and the core processes of schools.

This paper focuses on the use of group discussions, as a very open and flexible method of data generation, to learn about organisational characteristics of schools. In comparison to the more structured focus group method, the method of group discussion is less known; however, we demonstrate that it is a useful method to learn about how specific groups are constituted. The paper will draw on the findings and experiences of nine group discussions that were organised with teachers, students and parents in three schools in Austria. They were conducted as part of a case study to learn about the influence of schools’ organisational characteristics on the implementation of health promotion interventions. Group discussions were analysed using hermeneutic system analysis. We will present our findings, discuss benefits and limitations of using group discussions, and give recommendations for the future use within school (or organisational) research.

This multi-methods qualitative study aimed to identify environmental factors that influence physical activity participation among young people in Edinburgh, Scotland. School pupils (aged 11–13 years) took part using photography, computer blogs, maps and focus group discussions (FGDs). Eleven computer sessions (n = 131) and 14 FGDs (n = 63) took place. Factors influencing physical activity behaviour included proximity and access to local facilities, family and peers and the school physical activity environment. A variety of facilitators and barriers to participation were also reported. Most notable was the importance of cost and value for money when choosing physical activities which, although more evident among pupils attending schools in areas of low socio-economic status (SES), was relevant across all SES groups. Reporting easy access to sports facilities was more common among pupils attending schools from high/medium SES. Use of greenspace for physical activity was reported among pupils from all schools, but was more common among those from low SES schools. Pupils were, in general, satisfied with the facilities available at school, but felt time for physical education could be increased. Findings may help inform interventions, aimed at promoting physical activity at local level.

Objective: Improving the diet of the Scottish population has been a government focus in recent years. Population health is known to vary between geographies; therefore alongside trends and socio-economic inequalities in
eating behaviour, geographic differences should also be monitored.
Design: Eating behaviour data from the 2010 Scotland Health Behaviour in School-aged Children survey were modelled using multilevel linear and logistic modelling.
Setting: Data were collected in schools across urban and rural Scotland.
Subjects: Schoolchildren aged 15 years.
Results: Adolescents living in remote rural Scotland had the highest consumption frequency of vegetables (on average consumed on 6·68 d/week) and the lowest consumption frequency of sweets and crisps (on 4·27 and 3·02 d/week, respectively). However, it was not in the major four cities of Scotland (Glasgow, Edinburgh, Dundee and Aberdeen) but in the geography described by the classification ‘other urban’ areas (large towns of between 10 000 and 125 000 residents) that adolescents had the poorest diet. Deprivation and rurality were independently associated with food consumption for all but fruit consumption. Sharing a family meal, dieting behaviour, food poverty and breakfast consumption did not differ by rurality. Variance at the school level was significant for fruit and vegetable consumption frequencies and for irregular breakfast consumption, regardless of rurality.
Conclusions: Young people from rural areas have a healthier diet than those living in urban areas. The eating behaviours examined did not explain these differences. Future research should investigate why urban–rural differences exist for consumption frequencies of ‘healthy’ and ‘unhealthy’ foods.

Lay participation in health care decision making lacks an adequate analysis from an organizational perspective. This article aims to develop conceptual devices to analyze policies and practices and the ways in which these could be further developed. By recapping established frameworks and drawing on theories of professional organizations, four participatory roles and their potential to adapt organizational decisions to internal requirements and external challenges are elaborated. While individual patient participation is widely acknowledged, there is still a lack of systematic approaches to the roles of significant others, patient groups, and the broader community and their implementation within health care organizations.

Participatory evaluation has been increasingly used in health promotion (HP) and various forms of participatory evaluation have been put into practice. Simultaneously, the concept of participation has become more important for evaluation research in general, which is equally diverse and the subject of various discourses. This study addresses the issue of how the concept of participation has been established in HP evaluation practice. An analytical framework was developed, which served as a basis for a literature review, but can also be used as a general framework for analyzing and planning the scope of participation by various stakeholders within different phases of participatory evaluation. Three dimensions of participation, which refer to decision making (decision power, deliberation) and action processes are distinguished. The results show that only a few articles discussed participatory evaluation processes and participatory (evaluation) research was largely put forth by participatory (action) research in communities. The articles analyzed referred mostly to three stakeholder groups – evaluators, program staff and beneficiaries – and to participation processes in the initial evaluation phases. The application of the framework revealed that decision power seems to be held predominantly by program staff, evaluators seem to be more involved in action processes and beneficiaries in deliberation processes.

In this article, organizational structures in hospitals are discussed as possible capacities for hospital health promotion (HP) implementation, based on data from the PRICES-HPH study. PRICES-HPH is a cross-sectional evaluation study of the International Network of Health Promoting Hospitals & Health Services (HPH-Network) and was conducted in 2008–2012. Data from 159 acute care hospitals were used in the analysis. Twelve organizational structures, which were denoted as possible organizational health promotion capacities in previous literature, were tested for their association with certain strategic HP implementation approaches. Four organizational structures were significantly (p = 0.05) associated with one or more elaborate and comprehensive strategic HP implementation approaches: (1) a health promotion specific quality assessment routine; (2) an official hospital health promotion team; (3) a fulltime hospital health promotion coordinator; and (4) officially documented health promotion policies, strategies or standards. The results add further evidence to the importance of organizational capacity structures for hospital health promotion and identify four tangible structures as likely candidates for organizational HP capacities in hospitals.

Purpose - Reorienting health services towards health promotion is one of the major health promotion strategies stipulated by the Ottawa Charter. Important contradictions, tensions and barriers to health promotion implementation associated with organisational structures have, thus far, been underexposed in the hospital health promotion discourse. This paper aims at identifying risks and the chances for hospital management to strategically and sustainably reorient their hospitals towards health promotion.

Design/methodology/approach - The paper combines theories and findings from organisational science and management studies as well as from capacity development in the form of a narrative literature review. The aim is to focus on the conditions hospitals, as organisational systems with a highly professionalised workforce, provide for a strategically managed reorientation towards health promotion. Models and principles helping managers to navigate the difficulties and complexities of health promotion reorientation will be suggested.

Findings - Hospital managers have to deal with genuine obstacles in the complexity and structural formation of hospital organisations. Against this background, continuous management support, a transformative leadership style, participative strategic management and expert governance can be considered important organisational capacities for the reorientation towards a new concept such as health promotion.

Practical implications - This paper discusses managerial strategies, effective structural transformations and important organisational capacities that can contribute to a sustainable reorientation of hospitals towards health promotion. It supports hospital managers in exploring their chances of facilitating and effectively supporting a sustainable health promotion reorientation of their hospitals.

Originality/value - The paper provides an innovative approach where the focus is on enhanced possibilities for hospital managers to strategically manage the reorientation towards health promotion.

Comparable data on socio-economic position (SEP) is essential to international studies on health inequalities. The Health Behaviour in School-aged Children (HBSC) has used the Family Affluence Scale (FAS) on material assets. The present study used data collected from adolescents in eight countries in 2002, 2006 and 2010, and examined the construct validity of the FAS, by focusing on changes in item responses over time. The analyses reported the changes in means in item responses, and fitted models which estimated differential item functioning (DIF), and local dependency (LD) between items. DIF and LD were analysed by Graphical Log-Linear Rasch Models (GLLRMs), and changes in the measurement properties of the FAS over time and between countries were assessed. The results showed that the FAS items have changed their measurement properties between 2002 and 2010, and caution is warranted in studies comparing the FAS between different time points.

Sherriff,N., Gugglberger,L. (2013):

A European Seal of Approval for 'gay' business: findings from an HIV-prevention pilot project. Online First Published in: Perspectives in Public Health.

Aims: ‘Gay’ businesses can be important settings through which to deliver health promotion interventions to vulnerable populations, such as men who have sex with men (MSM) regarding HIV prevention. This article draws on data from the European Everywhere project, which represents the first scheme to develop and pre-test a common framework for HIV/STI prevention in ‘gay’ businesses across eight European countries.

Methods: The scientific basis of the Everywhere framework was developed using a comprehensive consensus-building process over 30 months. This process included: formative scoping research; interviews with 54 ‘gay’ businesses; meetings/workshops with representatives from project partners, ‘gay’ businesses, public health administrations and external experts; 15 interviews and three focus groups with project partners; a five-month pilot action phase in eight countries, together with support from the project’s Advisory Group; and all Everywhere project partners including the Scientific Steering Committee.

Results: A voluntary European code setting out differentiated HIV/STI-prevention standards for ‘gay’ businesses (including sex venues, ‘gay’ and ‘gay’ friendly social spaces, travel agencies, hotels, dating websites) was developed and piloted in eight European cities. During a five-month pilot action, 83 ‘gay’ businesses were certified with the Everywhere Seal of Approval representing a considerable increase on the expected pilot target of 30.

Conclusions: Everywhere offers a major contribution to the public health and/or health promotion field in the form of a practical, policy-relevant, settings-based HIV-prevention framework for ‘gay’ businesses that is common across eight European countries. Findings suggest that a European-wide model of prevention is acceptable and feasible to businesses.

Measuring health literacy in populations: Illuminating the design and development process of the European Health Literacy Survey Questionnaire (HLS-EU-Q). Accepted for Publication in: BMC Public Health.

Background: Several measurement tools have been developed to measure health literacy. The tools vary in their approach and design, but few have focused on comprehensive health literacy in populations. This paper describes the design and development of the European Health Literacy Survey Questionnaire (HLS-EU-Q), an innovative, comprehensive tool to measure health literacy in populations.

Methods: Based on a conceptual model and definition, the process involved item development, pre-testing, field-testing, external consultation, plain language check, and translation from English to Bulgarian, Dutch, German, Greek, Polish, and Spanish.

Results:The development process resulted in the HLS-EU-Q, which entailed two sections, a core health literacy section and a section on determinants and outcomes associated to health literacy. The health literacy section included 47 items addressing self-reported difficulties in accessing, understanding, appraising and applying information in tasks concerning decisions making in healthcare, disease prevention, and health promotion. The second section included items related to, health behaviour, health status, health service use, community participation, socio-demographic and socio-economic factors.

Conclusions: By illuminating the detailed steps in the design and development process of the HLS-EU-Q, it is the aim to provide a deeper understanding of its purpose, its capability and its limitations for others using the tool. By stimulating a wide application it is the vision that HLS-EU-Q will be validated in more countries to enhance the understanding of health literacy in different populations.